Multi-axial bone anchor system

ABSTRACT

A spinal implant system is disclosed for the fixation of bone segments in the spine. The system includes an elongated member, one or more bone anchor assemblies, and stabilizer members which are fitted within the elongated member. A bone anchor is attached to a bone, and the elongated member and stabilizer are fitted over the bone anchor. A rounded washer and nut having a corresponding rounded underside surface are fitted on to the bone anchor over the elongated member, and tightened. The configuration of the bone anchor assembly, including an intermediate portion of the bone anchor, the arcuate washer, and the nut, along with the configuration of the sliding support, allows multi-axial positioning of the bone anchor with respect to the elongated member at a plurality of locations along a slotted member.

This application claims the benefit of U.S. Provisional Application Ser.No. 60/129,587, filed Apr. 16, 1999, and U.S. Provisional ApplicationSer. No. 60/149,774, filed Aug. 19, 1999.

FIELD OF THE INVENTION

The present invention concerns orthopedic implants, particularly for thespine or long bones. Specifically, the present invention includes a boneanchor system having multi-axial capabilities, which may be used inconjunction with an orthopedic implant device such as a spinal plate orrod system.

BACKGROUND OF THE INVENTION

In the art of orthopedic surgery, and particularly in spinal surgery, ithas long been known to affix an elongated member, such as a plate orrod, to bones in order to hold them and support them in a givenposition. For example, in a procedure to fuse damaged vertebrae, thevertebrae are positioned in a corrected position as required by thesurgeon. A plate is placed adjacent to the bone, and bone anchors areemployed to secure the plate to the bones. Bone screws or bolts arecommonly utilized as the bone anchors, and with such anchors placementis accomplished by drilling one or more holes in the bone(s), andthreading the anchors into the holes. An example of a prior art bonebolt is described in a book by Dr. Cotrel entitled New Instrumentationfor Surgery of the Spine. Freund, London 1986. This bone bolt is shownin FIG. 1. An anchor can be threaded into a hole through the plate, orthe plate can be placed in position around the anchor after threadinginto the hole. The anchor and plate are then secured to each other toprevent relative movement. In this way, bones may be held and/orsupported in proper alignment for healing.

A spinal plate system or other similar implant system may have anchorsthat can be positioned at a number of angles with respect to the plateor other implant. Such a feature allows easier placement of implantsystems or correction of positioning of an implant system, in that thebone anchors need not be precisely positioned in angular relation withrespect to the implant. Rather, with a multi-axial capability, holes canbe drilled in a bone at a convenient location and/or angle, for example,and screws can be inserted therein, with the connection between theplate and the anchor being angularly adjustable to provide sufficientforce perpendicular to the plate/bone interface to secure the plate.

The plate system disclosed in U.S. Pat. No. 5,613,967 to Engelhardt, etal., discloses a slotted plate through which a bone screw extends. Thescrew includes cancellous threads for placement in bone, an intermediatesection with an upper flat portion, and a machine-threaded section. Themachine-threaded portion fits through the slot in the plate, and theplate abuts the flat portion of the screw or a flat washer imposedbetween the intermediate portion of the screw and the plate. A bracketis placed over the machine-threaded portion of the screw and the slottedplate, and a nut is threaded on the machine-threaded portion of thescrew to anchor the screw and plate together. This apparatus does notprovide the preferred multi-axial capability, as described above.

U.S. Pat. No. 5,084,048 to Jacob et al., discloses apparatus forclamping a rod to a bone screw such that the longitudinal planes of therod and screw are not perpendicular.

SUMMARY OF THE INVENTION

It is therefore an object of this invention to provide a spinal implantsystem having improved multi-axial capability and superior and strengthand ease of use, particularly with respect to the spine.

Another object of the present invention is to provide a lockingmechanism having a plurality of locking locations along a slottedmember.

Still a further object of the present invention is in a preferredembodiment to provide an improved spine system with multi-axialcapability and a plurality of locking locations along the systems.

Other objects will be evident from the following specification.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of a bone bolt used in a prior art spinalimplant system.

FIG. 2 is a perspective view of one embodiment of the system of thepresent invention.

FIG. 3 is a partial sectional view of the embodiment of the inventionillustrated in FIG. 1.

FIG. 4a is a top view of one embodiment of an orthopedic plate used withthe embodiment of the invention illustrated in FIG. 1.

FIG. 4b is a cross sectional view of the embodiment of the orthopedicplate illustrated in FIG. 4a, taken along the lines 4 b— 4 b in FIG. 4a.

FIG. 4c is a bottom view of the embodiment of the orthopedic plateillustrated in FIG. 4a, including a set of stabilizers according to theembodiment illustrated in FIGS. 7a and 7 b.

FIG. 4d is a side view of the embodiment of the orthopedic plateillustrated in FIG. 4a.

FIG. 4e is a top view of the embodiment of the orthopedic plate alongwith stabilizers as illustrated in FIG. 4c.

FIG. 5a is a side elevational view of one embodiment of a washer used inthe embodiment of the invention illustrated in FIG. 1.

FIG. 5b is a bottom view of the embodiment of the washer illustrated inFIG. 3a.

FIG. 5c is a sectional view of the embodiment of the washer illustratedin FIG. 3a.

FIG. 6a is a side elevational view of one embodiment of a break-off nutas used in the embodiment of the invention illustrated in FIG. 1.

FIG. 6b is a bottom view of the embodiment of the break-off nutillustrated in FIG. 4a.

FIG. 6c is a sectional view of the embodiment of the break-off nutillustrated in FIG. 4a.

FIG. 7a is a top view of one embodiment of the stabilizer used in theembodiment of the invention illustrated in FIG. 1.

FIG. 7b is a cross section of the embodiment of the stabilizerillustrated in FIG. 5a, taken along the direction of the arrows.

FIG. 8a is a top view of an alternate embodiment of an orthopedic plateaccording to the present invention.

FIG. 8b is a cross-sectional view, taken along the lines 8 b— 8 b inFIG. 8a and viewed in the direction of the arrows, of the embodiment ofthe orthopedic plate illustrated in FIG. 8a.

FIG. 8c is a cross-sectional view, taken along the lines of 8 c— 8 c inFIG. 8a and viewed in the direction of the arrows, of the embodiment ofthe orthopedic plate illustrated in FIG. 8a.

FIG. 8d is an end view of the superior end of the embodiment of theorthopedic plate illustrated in FIG. 8a.

FIG. 8e is a bottom view of the embodiment of the orthopedic plateillustrated in FIG. 8a.

FIG. 9a is a top view of an embodiment of a washer according to thepresent invention, viewed coaxially with a body portion of the washer.

FIG. 9b is a side view of the embodiment of the washer illustrated inFIG. 9a.

FIG. 9c is a bottom view of the embodiment of the washer illustrated inFIG. 9a.

FIG. 9d is a cross-sectional view, taken along the lines 9 d— 9 d ofFIG. 9b and viewed in the direction of the arrows, of the embodiment ofthe washer illustrated in FIG. 9a.

FIG. 9e is a cross-sectional view, taken along the lines 9 e— 9 e ofFIG. 9b and viewed in the direction of the arrows, of the embodiment ofthe washer illustrated in FIG. 9a.

FIG. 9f is a top view of the embodiment of the washer illustrated inFIG. 9a,viewed coaxially with an extension part of the washer.

FIG. 10a is a top view of an embodiment of a washer according to thepresent invention, viewed coaxially with a body portion of the washer.

FIG. 10b is a side view of the embodiment of the washer illustrated inFIG. 10a.

FIG. 10c is a bottom view of the embodiment of the washer illustrated inFIG. 10a.

FIG. 10d is a cross-sectional view, taken along the lines 10 d— 10 d ofFIG. 10b and viewed in the direction of the arrows, of the embodiment ofthe washer illustrated in FIG. 10a.

FIG. 10e is a cross-sectional view, taken along the lines 10 e— 10 e ofFIG. 10b and viewed in the direction of the arrows, of the embodiment ofthe washer illustrated in FIG. 10a.

FIG. 10f is a top view of the embodiment of the washer illustrated inFIG. 9a, viewed coaxially with an extension part of the washer.

FIG. 11a is a side view is an embodiment of a bone bolt of the presentinvention.

FIG. 11b is a side view of another embodiment of the bone boltillustrated in FIG. 11a.

FIG. 11c is a side view of another embodiment of the bone boltillustrated in FIG. 11a.

FIG. 11d is a side view of another embodiment of the bone boltillustrated in FIG. 11a.

FIG. 12 is a side view of an embodiment of a bone screw for use withpresent invention.

FIG. 13a is a top view of an embodiment of a nut for use with thepresent invention.

FIG. 13b is a side view of the embodiment of the nut illustrated in FIG.13a.

FIG. 13c is a cross-sectional view taken along the lines of 13 c— 13 cand viewed in the direction of the arrows, of the embodiment of the nutillustrated in FIG. 13a.

FIG. 14a is a top view of an embodiment of a rod-bolt connector for usewith the present invention.

FIG. 14b is a side view of the embodiment of the rod-bolt connectorillustrated in FIG. 14a.

FIG. 14c is a cross-sectional view, taken along the lines 14 c— 14 c ofFIG. 14a and viewed in the direction of the arrows, of the embodiment ofthe rod-bolt connector illustrated in FIG. 14a.

FIG. 14d is a cross-sectional view, taken along the lines 14 d— 14 d ofFIG. 14a and viewed in the direction of the arrows, of the embodiment ofthe rod-bolt connector illustrated in FIG. 14a.

FIG. 15a is a partial cut-away view of the embodiment of the rod-boltconnector illustrated in FIG. 14a with embodiments of a bone bolt,washer, nut and stabilizer of the present invention.

FIG. 15b is a cross-sectional view, taken along the lines 15 b— 15 b ofFIG. 15a and viewed in the direction of the arrows, of the embodimentsof the rod-bolt connector, bone bolt, washer, nut and stabilizerillustrated in FIG. 15a.

FIG. 16a is a top view of a second embodiment of the stabilizer of thepresent invention.

FIG. 16b is a side elevational view of the embodiment of the stabilizerillustrated in FIG. 16a.

FIG. 16c is a cross-sectional view, taken along the lines 16 c— 16 c ofFIG. 16b and viewed in the direction of the arrows, of the embodiment ofthe stabilizer illustrated in FIG. 16a.

FIG. 17a is a side elevational view of a third embodiment of thestabilizer of the present invention.

FIG. 17b is a bottom view of the embodiment of the stabilizerillustrated in FIG. 17a.

FIG. 17c is a cross-sectional view, taken along the line 17 c— 17 c ofFIG. 17a and viewed in the direction of the arrows, of the embodiment ofthe stabilizer illustrated in FIG. 17a.

FIG. 17d is a side elevational view of a second version of theembodiment of the stabilizer illustrated in FIG. 17a.

DESCRIPTION OF THE PREFERRED EMBODIMENT

For the purposes of promoting an understanding of the principles of theinvention, reference will now be made to the embodiment illustrated inthe drawings and specific language will be used to describe the same. Itwill nevertheless be understood that no limitation of the scope of theinvention is thereby intended, such alterations and furthermodifications in the illustrated device, and such further applicationsof the principles of the invention as illustrated therein, beingcontemplated as would normally occur to one skilled in the art to whichthe invention relates.

Referring generally to FIG. 2, one embodiment of an orthopedic implantsystem 20 according to the present invention is illustrated. In thatembodiment, implant system 20 includes an elongated member 22, a pair ofbone anchor assemblies 24, and a set of supports or stabilizers 26.Differing numbers of any of those elements may be utilized withoutdeparting from the scope of this invention. For example, a plurality ofelongated members 22 can be used in conjunction with each other, or agreater or lesser number of bone anchor assemblies 24 or stabilizers 26may be used, depending upon the configuration of the elongated member,the medical problem to be addressed, and/or any other factors. Thepresent invention contemplates at least one elongated member 22, atleast one bone anchor assembly 24 and at least one stabilizer 26.Additionally, the non-provisional United States patent applicationentitled “Multi-Axial Bone Anchor System,” filed on Mar. 15, 2000 in thename of the inventors of the present application, is hereby incorporatedby reference into the present application as though it were fully setforth herein.

Referring now generally to FIGS. 4a- 4 e, there is shown an embodimentof elongated member 22 according to the present invention. Elongatedmember 22 is in the form of a generally rectangular flat plate andincludes a generally longitudinal slot 30 through the thickness ofelongated member 22. Within slot 30 is formed a ledge 32. Elongatedmember 22 also includes a pair of downwardly-extending arms 34substantially along the length of both sides of elongated member 22.Arms 34 have an inwardly-extending ledge 36 along substantially theentire length of arms 34.

Referring now generally to FIGS. 2-7, there is shown one preferredembodiment of the bone anchor assembly 24 of the present invention.Generally, bone anchor assembly 24 includes a bone bolt 40, an arcuatewasher 42, and a break-off nut 44. In the illustrated embodiment, bonebolt 40 includes a bone-engaging portion 46 having cancellous threads 48thereon. Bone bolt 40 also includes a proximal portion 50, which isthreaded with machine threads. Between proximal portion 50 andbone-engaging portion 46, there is an intermediate portion 54 which hasa rounded configuration. In one specific embodiment, the roundedshoulder has a spherical configuration. The bone bolt is morespecifically described below.

Referring generally to FIGS. 5a- 5 c, arcuate washer 42 of bone anchorassembly 24 has a generally cylindrical body 60, a rounded or conicalhead 62, a underside projection 64, and an aperture 66 therethrough.Aperture 66 is bounded by inner walls 68 and 70 of washer 42. In theillustrated embodiment, inner wall 68 is conical or tapered such thataperture 66 decreases in diameter from head 62 toward body 60, and innerwall 70 is substantially cylindrical. Alternate configurations of walls68 and 70 are considered to be within the scope of the presentinvention. For example, inner wall 70 may not be contiguous with innerwall 68, or walls 68 and 70 may form a single conical surface boundingaperture 66. Projection 64 also bounds aperture 66, and in a specificembodiment the outer dimension of projection 64 is approximately squareand sized to fit within slot 30 and atop ledge 32 of elongated member22.

Further included in bone anchor assembly 24 is a break-off nut 44. Asshown more clearly in FIGS. 6a- 6 c, break-off nut 44 includes an upperbreak-off portion 76 and a nut portion 78. Both break-off portion 76 andnut portion 78 preferably have a hexagonal outer shape, although anyknown configuration of the outer portion of break- off portion 76 andnut portion 78 that will allow transmission of torque to one or both canbe used with the present invention.

Break-off nut 44 includes a longitudinal bore 80 therethrough. Bore 80,in a specific embodiment, is substantially cylindrical within break-offportion 76, and is substantially cylindrical with a female thread 82within nut portion 78. Approaching the bottom end of nut portion 78,bore 80 is bounded by a surface 84 for complementary mating with head 62of arcuate washer 42. While it is contemplated that the surfaces mayhave any configuration, in a preferred embodiment surface 84 isgenerally spherical, having a radius larger than the radius of bore 80,and substantially the same radius as the generally spherical head 62 ofwasher 42. Break-off nut 44 also includes a groove or weakened area 86that allows shearing separation of break-off portion 76 from nut portion78 after break-off nut 44 has been tightened sufficiently. Also includedin implant system 20 are one or more stabilizers or supports 26 (FIGS.7a and 7 b). Stabilizer 26, in one embodiment, has an approximatelysquare body 90 with an extending finger portion 92 on opposite sides ofstabilizer 26. Stabilizer 26 also has a bore 94 therethrough. Bore 94 isbounded by a conical or tapered wall 96 and substantially cylindricalwall 98. Alternative configurations of walls 96 and 98 are contemplatedas being within the scope of the present invention. For example, walls96 and 98 could be non-contiguous or walls 96 and 98 could form a singleconical wall bounding bore 94. Fingers 92 of stabilizer 26 are shapedand dimensioned to fit within slot 39 of elongated member 22 such thatfingers 92 abut ledges 36 and undersurface 37 of elongated member 22. Inthis embodiment, stabilizer 26 has a substantially flat bottom surface97. One or more stabilizers 26 may be inserted into slot 39 via an openend of elongated member 22, and until implant system 20 is finallytightened or locked as described below, are slidable along ledges 36 ofelongated member 22.

A second embodiment of stabilizer 26′ is illustrated in FIGS. 16a- 16 c.Stabilizer 26′ is like stabilizer 26 in most respects. However,stabilizer 26′ has a body 90′ approximately in the shape of aparallelogram. Finger portions 92′, bore 94′ and tapered wall 96′ aresubstantially similar to finger portions 92, bore 94, and tapered wall96 of stabilizer 26, described and illustrated above. As noted above,alternative configurations of the walls of bore 94′ are contemplated asbeing within the scope of the present invention. For example, taperedwall 96′ could be contiguous with or separate from a cylindrical wallwhich also bounds bore 94′. Fingers 92′ are shaped in dimension to fitwithin slot 39 of elongated member 22 such that FIGS. 92′ abut ledges 36and under surface 37 of elongated member 22. One or more stabilizers 26′may be inserted into slot 39 via an open end of elongated member 22, anduntil implant system 20 is finally tightened or locked as describedbelow, are slideable along ledges 36 of elongated member 22. Theparallelogram configuration of stabilizer 26′ allows close centerline-to-center line placement of bone bolts or screws when multiplestabilizers 26′ are placed adjacent each other, and can reduce theoverall thickness of the plate and stabilizer combination required forsuccessful fixation.

In a third embodiment, stabilizer 26″ is depicted in FIGS. 17a- 17 c.Stabilizer 26″ has an approximately rectangular body 90″ with extendingfinger portions 92″ on opposite sides of stabilizer 26″. Finger portions92″, like finger portions 92 and 92′, have flat undersides 93″ in oneembodiment. Alternatively, in another embodiment (FIG. 17d) fingerportions 92″ (and by extension, finger portions 92 and 92′ ofstabilizers 26 and 26′) can have convexly rounded undersides 93 a″.Stabilizer 26″ also has a bore 94″ therethrough. Bore 94″ is preferablybounded by a conical or tapered wall 96″, although alternativeconfigurations of wall 96″ are contemplated as being within the scope ofthe present invention, as discussed above with reference to stabilizers26 and 26′. Stabilizer 26″ also includes a rounded bottom surface 97″that substantially surrounds the lower opening of bore 94″. In onespecific embodiment of stabilizer 26″ rounded bottom 97″ has aconfiguration of a portion of a cylinder. Fingers 92″ of stabilizer 26″are shaped and dimensioned to fit within slot 39 of elongated member 22such that fingers 92″ abut ledges 36 and under surface 37 of elongatedmember 22. One or more stabilizers 26″ may be inserted into slot 39 viaan open end of elongated member 22, and until implant system 20 isfinally tightened or locked as described below, are slideable alongledges 36 of elongated member 22. While the description belowspecifically names only stabilizer 26, it is understood that stabilizers26′ and 26″ are used in the same manner.

Referring now generally to FIGS. 2 and 3, implant system 20 is assembledand used as follows. After the surgeon has drilled one or more holesinto a bone or bones, bone bolt 40 is threaded into the hole viacancellous threads on bone-engaging portion 46. After bone bolt 40 issecurely affixed to the bone, elongated member 22 including a fittedsupport or stabilizer 26 is placed over bone bolt 40, so that proximalportion 50 of bone bolt 40 extends through bore 94 of stabilizer 26 andslot 30 of elongated member 22, and such that intermediate portion 54 ofbone bolt 40 is within or adjacent to bore 94 of stabilizer 26. Washer42 is placed over proximal portion 50 of bone bolt 40, so that proximalportion 50 extends through aperture 66 of washer 42, and so thatunderside surface 63 of washer 42 rests on elongated member 22 andunderside projection 64 of washer 42 abuts ledge 32 within slot 30 ofelongated member 22. In the embodiment in which projection 64 has anapproximately square outer configuration, washer 42 will not be able torotate about bone bolt 40 when projection 64 is within slot 30 ofelongated member 22. When washer 42 is in place, break-off nut 44 isloosely threaded onto machine thread 52 of bone screw 40, such thatsurface 84 of nut portion 78 is in adjustable contact with or adjacentto head 62 of washer 42. Elongated member can then be adjusted withrespect to bone bolt 40, and bone bolt 40 may thereby form one of avariety of angles with respect to elongated member 22. The rounded part56 of intermediate portion 54 of bone bolt 40 is able to articulatewithin bore 94 and wall portion 96 of stabilizer 26, and inner wall 68of washer 42 permits proximal portion 50 of bone bolt 40 tocorrespondingly occupy various angular positions with respect to washer42 and elongated member 22.

After elongated member 22 is properly positioned with respect to bonebolt 40, break-off nut 44 is tightened. As break-off nut 44 istightened, the torque on break-off portion 76 increases, until break-offportion 76 shears away from nut portion 78 at groove 86. Preferably,groove 86 is above the uppermost portion of bone screw 40 to inhibitirritation to surrounding tissue that might be caused by a protrudingpost. Surface 84 of nut portion 78, being configured similarly oridentically to head 62 of washer 42, is able to matingly engage anyportion of head 62, enabling secure, tight contact between nut portion78 and washer 42 regardless of the angle between bone bolt 40 andelongated member 22.

An alternative embodiment 99 of the present invention is illustrated inFIGS. 8-13. Referring generally to FIG. 8, there is shown an elongatedmember 100 according to that alternative embodiment. Elongated member100 includes a superior end 102, an inferior or caudal end 104, and alongitudinal axis 106 generally extending there between. Typically, whenimplanted superior end 102 and inferior end 104 will be oriented ascephalad and caudal ends, respectively.

Superior end 102 includes a pair of longitudinal slots 108 and 110,which are placed transversely of each other. Slot 108 has aconfiguration very similar to the arrangement of slot 30 in elongatedmember 22. Slot 108 includes a ledge 112 near the upper part ofelongated 100, which substantially encircles slot 108 in one specificembodiment. It is contemplated that in another embodiment, slot 108 mayinclude two ledges 112, each running along substantially the entirelength of a longitudinal side of slot 108. Preferably, side walls 113,immediately adjacent ledges 112, form a rectangular configuration in theupper portion of slot 108. Slot 108 also has a lower ledge 114 that runssubstantially along each longitudinal side of slot 108. A stabilizer 115(similar to stabilizer 26 described above) may be placed to bear againstledge 114 as previously discussed with respect to the embodiment of FIG.2. Slot 110 includes a first arcuate or conical surface 116 near theupper surface of elongated member 100, and a second arcuate or conicalsurface 118 near the lower surface of elongated member 100. In aspecific embodiment, surfaces 116 and 118 are substantially circular incross-section. In a preferred aspect, the radius of surface 118 islarger than that of surface 116.

Inferior end 104 of elongated member 100 includes a pair of bores 120and 122. Bore 120 includes side walls 123 and a ledge 124 near the uppersurface of elongated member of 100. Side walls 123 define a generallysquare opening. Bore 120 further includes wall 126 which tapers outwardin a substantially conical shape from upper to lower surfaces ofelongated member 100. Bore 122 is a substantially circular bore, havingan arcuate surface 128 near the upper surface of elongated member 100.In a preferred embodiment, arcuate surface 128 is spherical.

Additionally, elongated member 100 includes a bend along axis 106,separating elongated member 100 into side portions 100 a and 100 b.Angle A between side portions 100 a and 100 b is approximately 163degrees in a preferred embodiment. Other inside angles A of elongatedmember 100 are contemplated as within the scope of the presentinvention, as may be required by the configurations of the bones towhich elongated member 100 is to be attached or other factors.

The embodiment of the implant system 99 incorporating elongated member100 also includes superior or cephalad washer 130 and inferior or caudalwasher 132. Referring to FIGS. 9a-f, superior washer 130 includes a bodyportion 134 having an conical or rounded head 136 and an underside 137having a projection 138, and a lateral extension portion 140. In theillustrated embodiment of washer 130, head 136 forms a portion of asphere, and underside projection 138 is flat and in the general form ofa square with rounded corners, with the sides of the square of a sizeslightly less than the width of slot 108 of elongated member 100. Anaperture 142 extends through body 134 of washer 130. An upper wallportion 144 bounds aperture 142, and is tapered from head 136 toward thebottom of washer 130. A lower wall portion 146 is generally cylindrical.However, other wall configurations are possible, for example, wallportions 144 and 146 may not be contiguous, or may form a single taperedwall from head 136 to projection 138.

Lateral extension portion 140 of washer 130 includes a C-clip portion148, which encloses most of an aperture 150, and downwardly extendingflanges 152 and 154. C-clip portion 148 has a pair of fingers 149 a and149 b. Fingers 149 a and 149 b have a beveled or substantially conicalprojection 156 at their respective upper portions. The interior openingdefined by projection 156 has a slightly smaller diameter than theinterior opening defined by walls 153 and 155. Flanges 152 and 154, in aspecific embodiment, have a length parallel to extension portion 140slightly smaller than the width of slot 110 of elongated member 100.Washer 130 also includes a bend in lateral extension portion 140 that iscomplementary to the bend along longitudinal axis 106 of elongatedmember 100. The inside angle B formed by the bend in washer 130 isapproximately the same as angle A of elongated member 100.

In use, washer 130 is fitted into slots 108 and 110 of elongated member100. Specifically, body portion 134 is placed on slot 108 such thatunderside 137 of body portion 134 rests on elongated member 100 andprojection 138 of body 134 is fitted into slot 108 and rests on ledge112. Flanges 152 and 154 of extension portion 140 are fitted into slot110. In this configuration, washer 130 cannot rotate with respect toelongated member 100 because of the respective fits between (a)projection 138 and the sides of slot 108, (b) flanges 152 and 154 andthe sides of slot 110, and (c) the bend in both washer 130 and elongatedmember 100.

Referring now generally to FIGS. 10a-f, an embodiment of inferior washer132 is illustrated. Washer 132 includes a body 160 having a conical orrounded head 162 and an underside 163 having a substantially squareprojection 164, and an extension 166. Body 160 has an aperture 168extending therethrough, extending from head 162 to projection 164.Aperture 168 is bounded by wall sections 170 and 172. In a specificembodiment, wall section 170 is conically tapered from head 162 towardunderside projection 164, and wall section 172 is substantiallycylindrical. Other configurations are possible, however, such as wallsections 170 and 172 being non-contiguous or forming a single conicallytapered surface.

Lateral extension 166 includes a C-clip portion 174, which encirclesmost of substantially cylindrical aperture 176. C-clip portion 174 has apair of fingers 175 a and 175 b. Fingers 175 b and 175 b have a beveledor substantially conical projection 178 at their respective upperportions. The opening defined by projection 178 has a diameter slightlysmaller than the diameter defined by walls 177 and 179. Washer 132 alsoincludes a bend in lateral extension portion 166 that is complementaryto the bend along longitudinal axis 106 of elongated member 100. Theinside angle C formed by the bend in washer 132 is approximately thesame as angle A of elongated member 100.

Referring generally to FIG. 11, there is shown a more detailed depictionof a form of bone bolt 200 which can be used with elongated member 100or elongated member 22. Bone bolt 200 includes a bone-engaging portion202, a proximal portion 204, and an intermediate portion 206.Preferably, bone-engaging portion 202 includes cancellous thread 208,which winds along the length of bone-engaging portion 202 until thread208 adjoins intermediate portion 206. As the thread pattern nearsintermediate portion 206, the root diameter of the thread increases.

Proximal end 204 includes a shaft portion 210 adjoining intermediateportion 206, a threaded portion 212 proximal of shaft portion 210, and abreak-off portion 214 proximal of threaded portion 212. In a specificembodiment, break off portion 214 includes torque applying surfaces 216(for example, hexagonal outer surfaces) to be engaged by a wrench orother nut-driver, and a groove or weakened portion 218. When bolt 200 issecure, further torque applied to torque applying surfaces 216 willcause break-off portion 214 to shear from threaded portion 212 at grooveor weakened portion 218. Break-off portion 214 is preferably configuredso that shear occurs when a relatively light torque is applied, e.g. inthe range of 10-11 newton-meters. Surface 216 may be used to preventbolt rotation while the bolt is connected to an elongated member by anut. Intermediate portion 206 of bolt 200 is generally rounded, andincludes a set of flattened areas 220. In a specific embodiment,flattened areas 220 are uniformly spaced around the circumference ofintermediate portion 206, in a hexagonal arrangement

Other alternative embodiments of bone bolt 200 are within the scope ofthe present invention. Referring to FIGS. 11b- 11 d, there areillustrated bone bolts 200 a, 200 b and 200 c. Bone bolt 200 a includesthe parts of bone bolt 200 identified above, but does not includebreak-off portion 214. Bone bolt 200 b includes, in addition to thefeatures of bone bolt 200, a machine threaded section 217 on break-offportion 214. Bone bolt 200 c includes a longer machine threaded section217′. Machine threads 217 and 217′ may be used to enable the surgeon toshear off break-off portion 214 without losing break-off portion 214 ordropping it into the patient. Further, maching threads 217′ havesufficient length to allow reduction of stripped vertebra. A cannulatedtool having a female thread at its distal end and inner surfaces fortorque application (e.g., hexagonal inner surfaces for engaging torqueapplication surfaces 216 of break-off section 214) could be threadedonto machine threads 217 or 217′, and the inner torque surfaces of thetool engaged with break-off portion 214. When break-off portion 214 issheared from bolt 200 b or 200 c, break-off portion 214 is held by thetool by virtue of the interengaged female tool thread and machinethreads 217 or 217′ of break-off portion 214 of bolt 200 b or 200 c.

Now referring generally to FIG. 12, there is illustrated bone screw 230of the present invention. Bone screw 230 includes a bone engagingportion 232 having cancellous threads 243 thereon, and a head portion236. Head portion 236 includes a lower rounded surface 248 and an upperrounded surface 240. In a specific embodiment, surfaces 238 and 240 areseparated by a generally cylindrical portion 242. Head 236 also includesa tool-engaging recess 244. Tool-engaging recess 244 may be of anysuitable configuration, including hexagonal, hexalobed, or otherconfiguration.

Referring now generally to FIGS. 13a-c, nut 250 of the present inventionis illustrated. Nut 250 includes outer torque application surfaces 252and an aperture 254 extending longitudinally through nut 250. Aperture254 includes threads 256, which extend from the top of nut 250 towardthe bottom of nut 250. Aperture 254 widens near the bottom of nut 250,and is bounded by walls 258. In a preferred embodiment, walls 258 aresubstantially spherical. However, other configurations are contemplated,such as conical.

In use, elongated member 100, washers 130 and 132, bolt 200, screw 230and nut 250 are used in connection with stabilizer 26 or 115 as follows.In vertebrae, long bones, or other bone tissue, holes are drilled intothe tissue for engagement of bone bolts 200 via cancellous threads 208.Bolts 200 are threaded into the drilled holes, and when bolts 200 aresatisfactorily seated. Elongated member 100 is placed over bolts 200, sothat proximal portions 204 of bolts 200 extend through slot 108 and bore120, respectively. In the embodiment in which stabilizer 26 is placed inslot 108 on ledge 114 of elongated member 100 the proximal portion 204of one bolt 200 extends through the aperture of stabilizer 26 as well.When elongated member 100 is properly placed, the sides of slot 108 arepreferably adjacent to one or more flat portions 220 of one bolt 200.

Washer 130 is then fitted so that the bolt 200 extending through slot108 also extends through aperture 142 of washer 130, projection 138 ofwasher 130 fits within slot 108 and on top of ledge 112 of elongatedmember 100, and downwardly-extending flanges 152 and 154 fit within slot110 of elongated member 100. Positioned thusly, washer 130 is not ableto rotate about bolt 200 due to the engagement of projection 138 withslot 108 and flanges 152 and 154 with slot 110. Washer 132 is fittedover the bolt 200 within bore 120, so that underside projection 164 ofwasher 132 rests on ledge 124 within bore 120, and such that aperture176 of washer 132 and bore 128 of elongated member 100 are roughlyaligned.

Holes may be drilled through bore 128 and slot 110 for screws 230.Alternatively, holes for screws 230 may be drilled prior to fittingwashers 130 and 132 to elongated member 100, or may be drilled at thesame time holes for bolts 200 are drilled. A bone screw 230 is threadedinto a hole in the bone tissue through aperture 176, washer 132, andbore 128 at inferior end 104 of elongated member 100, and a separatescrew 230 is threaded into a separate hole in the bone tissue throughaperture 150 of washer 130 and slot 110 at superior end 102 of elongatedmember 100. As screw 230 is threaded into the bone, head 236 comes incontact with C-clip portion 174 of washer 132. Lower rounded surface 238of screw 230, as the screw is threaded into the bone, pushes outward ontapered surface 178 of washer 132, forcing fingers 175 a and 175 b ofC-clip portion 174 to open. When screw 230 is threaded far enough sothat cylindrical portion 242 substantially passes tapered portion 178,fingers 175 a and 175 b of C-clip portion 174 close together, therebypreventing screw 230 from backing out under loads. In one embodiment,the closing of fingers 175 a and 175 b produce a positive feedback, suchas an audible “click” apprising the surgeon that the screw has beensufficiently threaded. A similar or identical procedure is used tothread a second screw 230 into bone tissue through washer 130 and slot108. C-clip portions 174 and 148 can be “tuned” to produce somewhatdifferent sounds and/or to alter the strength of portions 174 and 148and thereby alter the backing-out or threading force required to passcylindrical portion 242 of screw 230 backward or forward throughportions 174 or 148. This can be accomplished by making C-clip portions174 and 148, and particularly fingers 175 a and 175 b and 149 a and 149b thereof, thicker or thinner or by placing aperture 176 or 150eccentrically with respect to washer 132 or 130 respectively.

When it is determined that elongated member 100 is in the properposition with respect to bolts 200 and/or screws 230, nuts 250 arethreaded onto threaded portions 212 of bolts 200. Surface 258 of one nut250 is generally configured with a substantially similar shape to head162 of washer 132, and surface 258 of a second nut 250 is generallyconfigured with a substantially similar shape to head 136 of washer 130.Thus, as nuts 250 are torqued onto bolts 200, respective surfaces 258are pressed against surfaces 136 and 162 in a close fit. If desired,upper surfaces 216 may be engaged by a tool during nut tightening toresist rotation of the bolt and after nut tightening torque may beapplied to surfaces 216 to shear off the post.

Elongated member 100 may be positioned with respect to bolts 200 suchthat the longitudinal axes of bolts 200 are not perpendicular to sides100 a or 100 b. Wall portion 144 of washer 130 and wall portion 170 ofwasher 132 are tapered, as noted above, to accommodate the positioningof a bolt 200 along a variety of angles with respect to elongated member100. Further, wall surface 96 of a stabilizer 26 placed within slot 108on ledge 114 of elongated member 100 also accommodates the angle of abolt 200. In the case in which a bolt 200 is not perpendicular withrespect to slot 108 and/or bore 120, nut 250 is not squarely on top ofhead 162 or 136 of washer 132 or 130, but is off to one side. In thatsituation, surface 258 of nut 250 and head 162 or 136 may still bepressed together in a close fit due to the similar or identicalconfigurations of surface 258 and heads 162 and 136.

Alternate embodiments of the structures disclosed herein are consideredto be within the present invention. For example, tabs 152 and 154 onwasher 130 may be left out as long as underside portion 138 of washer130 and slot 108 of elongated member 100 are configured to preventrotation of washer 130 with respect to elongated member 100 when washer130 is engaged to elongated member 100. Further, it is contemplated thatdiffering sizes of parts or of apertures within parts are within thepresent invention. Moreover, underside projections 164 and 138 ofwashers 132 and 130 are depicted as having a particular spatial andangular relationship with extension portion 166 and 140 of washers 132and 130. Alternate embodiments of this configuration are considered tobe within the scope of the present invention, e.g. placing extensionportion 166 and 140 directly to one side of underneath projection 164 or138, rather than placed off a corner of such projections.

Referring generally to FIGS. 14a- 15 b, there is shown an embodiment ofa rod-bolt connector 270. Connector 270 includes a roughly C-shapedportion 272 and an extension portion 274. C-shaped portion 270 includesan upper portion 276 and a lower portion 278 defining an opening 280into which a rod (not shown) can be fitted. Upper portion 276 includes athreaded bore 282 into which a set screw or other threaded piece (notshown) can be fitted to hold the rod within opening 280. Extensionportion 274 includes a slot 284 which is configured substantiallysimilarly to slot 108 of elongated member 100 and/or slot 30 ofelongated member 22. Connector 270 can be used with bone boltembodiments such as bone bolt 40 or 200, washer embodiments such aswashers 42, 130 or 132, nut embodiments such as nuts 44 or 250, andstabilizer embodiments such as stabilizers 26 or 115, as furtherillustrated in FIGS. 15a- 15 b.

The parts of the implant system of the present invention may be madeavailable in the form of kits containing a plurality of sizes andconfigurations of a single part, or a plurality of sizes andconfigurations of all parts that can be included in the system of thepresent invention. Such kits may include, for example, a set ofelongated members 22 and/or 100 of various lengths and having differingnumbers or orientations of slots and/or bores. In the case of elongatedmember 100, a kit could include a set of elongated member having varyingdegrees of bend along longitudinal axis 106. Sets of washers, bolts,screws and nuts as disclosed herein can also be provided. Further, toolssuch as wrenches and screwdrivers compatible with the parts of theimplant system of the present invention may also be included.

The devices of the present invention are preferably constructed ofsturdy bio-compatible materials, such as stainless steel, titanium,certain plastics, or other known materials.

While the invention has been illustrated and described in detail in thedrawings and foregoing description, the same is to be considered asillustrative and not restrictive in character, it being understood thatonly the preferred embodiment has been shown and described and that allchanges and modifications that come within the spirit of the inventionare desired to be protected.

What is claimed is:
 1. An orthopedic implant, comprising: a longitudinalmember, said longitudinal member having a lower side for facing a bone,an upper side for facing away from a bone, and an aperture through saidlongitudinal member from said first side to said second side, saidlongitudinal member further including a longitudinal channel parallel toand between said first and second sides, said channel beingsubstantially perpendicular to said aperture; a stabilizer having anopening therethrough bounded by a conical surface, said stabilizerfurther having a plurality of laterally extending fingers occupying saidchannel so that said stabilizer is in one of an infinite number ofpositions wherein said opening is adjacent to said aperture of saidlongitudinal member; a fixation member having a first threaded portionfor fixing to a bone, a second threaded portion, and a diametrallyenlarged portion between said first and second threaded portions, saidenlarged portion including a plurality of torque transmission surfaces,and said fixation member extending through said stabilizer and saidlongitudinal member so that said enlarged portion contacts a portion ofsaid surface bounding said opening of said stabilizer; a washer having arounded top, said washer adapted for placement over said second threadedpart of said fixation member and into contact with said second side ofsaid longitudinal member; and a nut having a rounded underside andadapted to be threaded onto said second threaded portion of saidfixation member and down onto said washer, to thereby lock said fixationmember in place relative to said longitudinal member.
 2. The implant ofclaim 1, wherein said channel is continuous and extends throughsubstantially the entire length of said longitudinal member.
 3. Theimplant of claim 1, further comprising at least one additionalstabilizer each having an opening therethrough bounded by a conicalsurface, said at least one additional stabilizer further each having aplurality of lateral fingers occupying said channel so that said atleast one additional stabilizer is in a preselected one of an infinitenumber of positions wherein said opening of said at least one additionalstabilizer is adjacent to said aperture of said longitudinal member. 4.The implant of claim 3, further comprising at least one additionalfixation member each having a first threaded portion for fixing to abone, a second threaded portion, and a diametrally enlarged portionbetween said first and second threaded portions, said enlarged portionof said at least one additional fixation member including a plurality oftorque transmission surfaces, and said at least one additional fixationmember extending through a corresponding one of said at least oneadditional stabilizer and said longitudinal member so that said enlargedportion of said at least one additional fixation member contacts aportion of said surface bounding said opening of said correspondingstabilizer.
 5. The implant of claim 1, wherein said opening in saidstabilizer has a longitudinal axis, and said stabilizer substantiallyforms a parallelogram in a plane substantially perpendicular to saidaxis.
 6. The implant of claim 5, wherein said stabilizer substantiallyforms a square in a plane substantially perpendicular to said axis. 7.The implant of claim 1, wherein said washer has a bottom surface forcontacting said longitudinal member that includes a substantially flatportion and a projection extending substantially perpendicularly fromsaid bottom surface.
 8. The implant of claim 7, wherein saidlongitudinal member has a ledge within said aperture and said apertureis bounded above said ledge by substantially parallel wall sections, andsaid projection of said washer is configured to fit within said apertureand rest on said ledge.
 9. The implant of claim 8, wherein saidprojection of said washer is configured to cooperate with saidsubstantially parallel wall sections to minimize rotation of said washerwith respect to said longitudinal member.
 10. The implant of claim 9,wherein said projection is substantially square.
 11. The implant ofclaim 7, wherein said washer includes a hole therethrough bounded by awall that has a conical portion.
 12. The implant of claim 1, whereinsaid nut includes a break-off portion that is severed when a torqueexceeding a predetermined amount is applied to said break-off portion.13. A spinal implant system, comprising: a plate member having alongitudinal axis, a first end and a second end, said first end having afirst slot and a second slot extending through said plate member, saidslots being substantially parallel to and offset from said axis and saidfirst slot having a longitudinal channel formed therein, said second endhaving a first aperture and a second aperture through said plate member;a stabilizer having an opening therethrough bounded by a conicalsurface, said stabilizer further having a plurality of lateral fingersoccupying said channel so that said stabilizer is in a preselected oneof an infinite number of positions wherein said opening is adjacent tosaid first slot; a fixation member having a first threaded portion forconnection with a bone, a second threaded portion, and an enlarged headportion between said threaded portions for spacing said stabilizer andsaid plate member from said bone, said fixation member extending throughsaid opening of said stabilizer and said first slot; a washer having abody portion with a convex upper portion, a substantially flat lowersurface, and a hole therethrough, said washer further including a flangeportion extending laterally from said body portion, said flangeincluding a C-clip, said washer being adapted for placement around saidfixation member so that said C-clip extends above a portion of saidsecond slot; and a nut having a concave underside, said nut beingthreaded on said second threaded portion of said fixation member,whereby said plate member, stabilizer, fixation member, washer and nutare locked in cooperation with each other.
 14. The system of claim 13,further comprising a screw having a threaded portion and a head portion,said head portion having a lower convex portion, an upper portion, and asubstantially cylindrical portion between said upper and lower portions;and said screw extending through said C-clip and said second slot andinto a bone.
 15. The system of claim 14, wherein said second slot has abeveled upper edge adapted to accommodate said lower convex portion ofsaid head portion of said screw.
 16. The system of claim 14, whereinsaid C-clip has an inner diameter smaller than the diameter of saidcylindrical portion of said head portion of said screw.
 17. The systemof claim 14, wherein said lower convex portion of said head of saidscrew is spherical.
 18. The system of claim 17, wherein said upperportion of said head of said screw is spherical.
 19. The system of claim14, wherein said screw has a longitudinal axis, said upper portion andsaid lower portion of said head have respective maximum diameters withrespect to said screw axis, and said diameter of said cylindricalportion is greater than said diameters of said upper portion and saidlower portion.
 20. The system of claim 19, wherein said head portion ofsaid screw includes a tool-insertion recess.
 21. The system of claim 13,wherein said enlarged head portion of said fixation member has aplurality of substantially flat torque transmission surfaces.
 22. Thesystem of claim 13, wherein said enlarged portion of said fixationmember overlaps with one of said threaded portions.
 23. The system ofclaim 22, wherein said first threaded portion of said fixation memberhas a head surface and a root diameter that increases toward saidenlarged head portion so that said head surface is substantially acontinuation of said root diameter.
 24. The system of claim 13, whereinsaid flange portion of said washer is non-parallel with saidsubstantially flat lower surface.
 25. The system of claim 24, whereinsaid flange portion of said washer forms an obtuse angle with saidsubstantially flat lower surface.
 26. The system of claim 13, whereinsaid flange portion includes lower surface and a secondary flangeextending from said lower surface.
 27. The system of claim 13, whereinsaid hole through said body portion of said washer is bounded by a wallhaving a conical upper portion.
 28. The system of claim 13, furthercomprising a second fixation member having a first threaded portion forconnection with a bone, a second threaded portion, and an enlarged headportion between said threaded portions, said second fixation memberextending through said first aperture and into a bone, a second washerhaving a body portion with a convex upper portion, a substantially flatlower surface, and a hole therethrough, said washer further including aflange portion extending laterally from said body portion, said flangeincluding a C-clip, said washer being adapted for placement around saidsecond fixation member so that said C-clip extends above a portion ofsaid second aperture, and a second nut having a concave underside, saidnut being threaded on said second threaded portion of said secondfixation member, whereby said plate member, second fixation member,second washer and second nut are locked in cooperation with each other.29. The system of claim 28, further comprising a second screw having athreaded portion and a head portion, said head portion having a lowerconvex portion, an upper portion, and a substantially cylindricalportion between said upper and lower portions; and said second screwextending through said C-clip and said second aperture and into a bone.30. The system of claim 29, wherein said C-clip has an inner diametersmaller than the diameter of said cylindrical portion of said headportion of said screw.
 31. The system of claim 13, wherein said secondthreaded portion includes a break-off groove.
 32. The system of claim31, wherein said second threaded portion includes an end portion havinga driving print thereon.
 33. The system of claim 32, wherein saiddriving print includes a plurality of external surfaces for torquetransmission.
 34. The system of claim 13, wherein said C-clip portion ofsaid washer is integrally formed with said flange portion.